Blood test, clotting time (PTT)
Facility: Greenwood County Hospital
Billing Code: 85730 (CPT)
- CPT Billing Code: 85730
- Insurance Median: $57
- Cash Discount Price: $54
- vs. Medicare Baseline: 9.48x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $6.01 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 948% of the Medicare baseline (a markup of 848%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $4 - $56 | 67% |
| Blue Cross Blue Shield | $21 - $22 | 349% |
| Triwest - All Plans | $24 | 399% |
| Tricare | $28 | 466% |
| Choicecare Mcr Adv - All Plans | $28 | 466% |
| Integrated Health Plan - All Plans | $50 | 832% |
| Beech Street - All Plans | $57 | 948% |
| First Health - All Other Plans | $57 | 948% |
| First Health Ccn Network | $57 | 948% |
| Preferred Hs (Coventry) - All Plans | $60 | 998% |
| Principal Health Care Inc - All Plans | $64 | 1065% |
| Amerigroup Mcaid-All Plans | $67 | 1115% |
| Medicaid / KanCare | $67 | 1115% |
| Providrs Care/Wppa - All Plans | $100 | 1664% |
Consumer Guidance & Cost Commentary
For the CPT code 85730, representing a blood test for clotting time (PTT), Greenwood County Hospital in Eureka, Kansas, lists a cash median price of $54.00 and a median negotiated rate of $57.00. The facility's gross charge is $67.00, which is notably higher than the Medicare benchmark of $6.01, indicating a significant markup common in commercial billing. While the negotiated rates range from $4.00 to $100.00 across 14 different payers, the cash price offers a lower baseline for patients without insurance. It is important to note that for individuals with high-deductible plans, paying the cash price of $54.00 upfront may result in lower out-of-pocket costs compared to the negotiated rate of $57.00, provided the patient's insurance deductible has not yet been met. Patients should verify their specific plan's allowed amount and inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these programs can further reduce the final cost.
Patients should be aware of the risks associated with balance billing if they receive care from out-of-network providers, where the hospital could bill the difference between the full charge and the insurance payment. However, the No Surprises Act provides federal protections against such surprise bills for emergency care and non-emergency services at in-network facilities, making it crucial to confirm the network status of the facility and any ancillary services. If a patient receives an unexpected bill, they should not pay immediately but instead request an itemized billing audit to identify errors, unbundled codes, or services not rendered, as over 8